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[ Why do people develop diabetes after contracting COVID-19? ]

For some people, surviving COVID-19 can lead to long-lasting medical problems, including newly diagnosed diabetes. This is a chronic disease that occurs when your blood sugar, also called blood sugar, is too high. The pancreas produces insulin, a hormone that helps glucose enter cells for use for energy. But when your body doesn’t make enough (or not at all) insulin (type 1 diabetes) or doesn’t use insulin well (type 2 diabetes), glucose stays in the blood and can cause problems. health. In November 2020, a global analysis published in the journal Diabetes, Obesity and Metabolism found that up to 14.4% of people hospitalized with severe COVID-19 also developed diabetes. But why? The real question is whether there is an association with the viral infection or whether the coronavirus disease simply led to diabetes sooner than it would otherwise have been identified. What does the data say? I have yet to see any data indicating that there is an inherent property in this virus to directly affect the pancreatic beta cells responsible for producing the insulin the body needs to process glucose. The response of these patients to insulin therapy does not suggest such a mechanism. Keep in mind that 90% of the 88 million people with prediabetes don’t know they have prediabetes, even though this is the group most at risk for immediate progression to a diagnosis of type diabetes. 2. What’s more, 25% of the 34 million people with diabetes have not yet been diagnosed, according to the most recent 2018 data from the Centers for Disease Control and Prevention. What are the causes of diabetes? People at risk for type 2 diabetes have an altered relationship between insulin production and insulin resistance that is already present at birth. However, this relationship can work and keep blood sugar within the normal range for more than 70 years, as long as nothing imbalances it. The main stressors that can upset this delicate balance are diet (both absolute calories and the amount and type of fat), weight and lack of exercise. Acute stressors such as pregnancy, steroids, or cytokine-triggered inflammation often seen in patients with COVID-19 can lead to hyperglycemia in a person who is not known to have diabetes or diabetes. prediabetes. These acute stressors are like a “pancreatic strip test” and the pancreas fails. The pancreas that is at risk for type 2 diabetes cannot acutely increase insulin production in response to these acute stressors, so glucose rises. In fact, this is a warning sign that the pancreas does not have enough reserves to handle stress and may progress to high blood sugar and a diagnosis of type 2 diabetes in the near future. Unfortunately, we are used to calling this gestational diabetes, steroid-induced diabetes, or stress hyperglycemia (respectively), as blood sugar levels often seem to return to normal after the acute stressor resolves. How could COVID-19 cause type 1 diabetes? Epidemiological data showed many years ago that type 1 diabetes is most often diagnosed after an acute illness, such as viral gastroenteritis or the flu. We have learned that this previous disease causes the body’s immune system to increase the production of all antibodies, including pre-existing ones, such as those directed against islet cells in the pancreas that produce insulin. This attack of the immune system leads to a sudden loss of insulin-producing beta cells, causing acute hyperglycemia, also known as hyperglycemia. Once the activation of the immune system wanes as the acute illness resolves, the pancreas can resume insulin production. When this happens, the person experiences a “honeymoon phase” in which glucose regulation is not normal, but the insulin deficit is not absolute and minimal insulin doses are required. This honeymoon period can last anywhere from 1 to 10 years in adults and often ends suddenly, requiring daily doses of insulin. The honeymoon period occurs because there are still insulin-producing cells that the autoimmune process takes longer to destroy. How could COVID-19 cause type 2 diabetes to appear? Here are three scenarios that could explain why a person may be diagnosed with type 2 diabetes after surviving a COVID-19 attack. The person has the disease, but has not yet been diagnosed. The person may have prediabetes, and acute inflammation and / or steroid treatment eventually led to diabetes. For example, the acute stressor increased his insulin resistance enough to reveal the relative deficiency in insulin production, and his glucose level rose above normal. The person may have been at genetic risk with mild stressors, such as being overweight (not obese) and mildly but not completely sedentary. But then the combination of insulin resistance from acute infection and the high dose steroids used to treat COVID-19 was such that a significant increase in insulin production was needed to maintain normal blood sugar levels. , and the pancreas just couldn’t do it. increase your production to this level. However, we do know that in all three scenarios, most patients still have “prediabetes” six months later and will likely progress to a diagnosis of type 2 diabetes within five years. In addition, most, if not all, will be officially diagnosed with diabetes in their lifetime. If you’ve had COVID-19, what are the warning signs that you may have developed diabetes? Frequent urination This may include waking up at night to urinate and / or more frequently during the day. Increased thirst with blurred vision. Inability to regain lost weight while seriously ill. Slow wound healing. Fatigue. This one is difficult because most people with COVID are tired for a long time after the acute illness. What can you do to prevent diabetes after COVID-19? Focus on losing 15 pounds. From data from prediabetic populations, we know that it can significantly slow the progression to type 2 diabetes. Losing more weight can also help, but those first 15 pounds are the most important. But, if you have lost a lot of weight during the acute illness, your goal should be to gain muscle but not to gain back all of the total weight lost. A reasonable goal is to aim for a body mass index (BMI) below 25, or 23 if you are of Asian descent. Establish a regular exercise program. This will help maintain insulin sensitivity and body weight and slow the progression to type 2 diabetes. This exercise can be as easy as walking every day. Evaluate your pre-COVID diet. Start by making a few small changes to maintain your weight or lose weight, such as switching from sugary drinks to sugar-free drinks or water. Ask your PCP for a formal diabetes test on your first visit after discharge. Ask to be tested again six months after discharge, then once a year. Why is it important to see a doctor for diabetes? Uncontrolled hyperglycemia (high blood sugar) damages blood vessels and nerves throughout the body, which can damage the eyes, kidneys, and heart, as well as the loss of sensation in the feet associated with amputations. . Hyperglycemia is also associated with the accumulation of fat in the liver and muscles, leading to fatty liver disease and heart failure. These effects of hyperglycemia are usually present at the time of diagnosis of diabetes. However, we do know that it takes at least five years of high blood sugar to start developing these complications, so anyone whose blood sugar is not normal after their COVID-19 illness has likely already started developing these complications. . Intensive glycemic control initiated early in the disease process can dramatically increase the time to onset or progression of these complications. We must be careful to use COVID-19 related hyperglycemia as a warning sign that type 2 diabetes is going to arise in a person’s life, but that they have the opportunity to take steps to delay or delay progression to hyperglycemia. for diagnosis. Patients can use this warning sign to delay the diagnosis of diabetes for many years by making the necessary adjustments to their overall lifestyle.